# Urine culture and urinalysis utilization practices in United States acute care hospitals between 2017 and 2020

## TL;DR

This study examines how urine cultures and urinalyses are used in U.S. hospitals from 2017 to 2020, finding a decrease in urine cultures and an increase in those with positive urinalysis results.

## Contribution

The study provides a national assessment of the impact of diagnostic stewardship on urine culture and urinalysis practices.

## Key findings

- The overall rate of urine cultures decreased from 129.2 to 120.0 per 1000 discharges between 2017 and 2020.
- The proportion of urine cultures with a positive urinalysis increased from 60.5% to 68.1% during the study period.
- Male sex, age under 65, and a cancer diagnosis were predictors of urine cultures with negative or no urinalysis.

## Abstract

Inappropriate urine cultures (UCs) are common and lead to inappropriate antimicrobial use. Urinalyses (UAs) have been increasingly incorporated into diagnostic stewardship interventions, but the impact of these interventions nationally has not been assessed. We describe UA and UC utilization practices using a nationwide dataset of patients admitted to acute care hospitals.

Design, Setting and Participants: We performed a retrospective cohort study of index UCs and their associated UAs performed for adult patients (age ≥ 18 years) admitted in U.S. acute care hospitals, participating in the PINC AI™ Healthcare Database (PHD) from January 1, 2017, through December 31, 2020. A positive UA was defined as >10 leukocytes per high power field, positive leukocyte esterase, or positive nitrite.

The overall rate of UCs in this study was 124.7 per 1000 discharges and annual UC rates decreased from 2017 (129.2) to 2020 (120.0). The proportion of UCs that had a positive UA increased from 60.5% in 2017 to 68.1% in 2020; UCs without a UA decreased from 19.3% to 10.5%, and UCs with a negative UA did not significantly change (20.2% to 21.5%). A multivariate multinomial logistic regression model identified male sex, age <65, and a diagnosis of cancer to be predictors of having a UC with a negative UA or no UA.

UC utilization decreased over the study period. The proportion of UCs with a positive UA increased. This may suggest a positive impact of diagnostic stewardship practices at the national level although further progress is needed.